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HomeMy WebLinkAboutMiscellaneous - 59 BONNY LANE 4/30/2018 (3) 59 BONNY LANE I --P- 2101062.0-0056-0000.0 P-21oios2.aoo5s-0000.o SLE Scp-04 97 ,\ Y ./—'- �1. . . 'T y '' •1 1 r ///ll%� �^..r fit• O e re.x' ....._. ....r._....,...v..�.-.._•.—i s- ..._�.-.....-.........�..,_.....-..,;,..•...�cv�'..M A.•�..._.. _..:L!....._.�tt t;:r,.fe(•1�.-.t.t. �e��.. ... _ . .. ... NG:Q•�d 1' CC,t'7�iR Y 7T1 Y.4�Gr rirG E /c/S t�C1 Gt �iy 1"-4C�. L s� J �'� •'�/ 777 �"1Jtr IA�AW 7�wgy, XiWE-'04- Ze_Rttf /S eat-wino AN TySef 40r_AS .Y.�PA-s/,�.VO T/�47"/T port CGtt%�4",v/ r•' ' lY/lA� -IJl4a' YYJs+✓ G«".v A�00�fiE 2►O�lw/ 11P4 ..►ra'�%i ,pw- .5"r"1ViNf .la�7f��rt �' /J�l'r SJXCt7".S ! COT t.�n KJ /�r'r'.. �� '�.�s�-. : l:-�r." •1"" i' z . .^!�. � 6i:r"rl•4Tt C��i'rv�'/ Ti{SI7 Ti�CI L3ryTui.+•fs /l..Vny ' 1-NaC —0 eNn �9.c'd Pr's .6.tSC%�. I�•S�%P i{/ t^}��� v�T• Of � ta4rg.__ .► C. r� f a<� T /S Vk a46�'A•P•.+PV' its/�' .�'Berc•'L►•e.�'Y/�:�fi'_N- fe ��L7©r;�'-'y M1la�a7l�C�d(^,G i [� •�.! trryi /ate d �aA.' �a A­�--/ N2 r r r Date...... j f NORTH, 3?°.<;�`".;•�."ao� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACNUS� This certifies that ..........I V\a 2...k.......0. Ala.!...5............................... has permission to perform ....... .l!Gf.cdY. ............................................ wiring in the building of....... • Ivkn z.n..:/......../—.N.............. _ North Ann/ Mass. Fee. J�.:.4 .. Lic.No. S \\�a?�Tf.YZ..,� ........... ..... .... .................... i ELECTRICALINSPECTOR C WHITE:Applicant CANARY: Buildin Dept. PINK:Treasurer The Commonwealth of Massachusetts Office Use Only Department of Public Safety Permit# Board of Fire Prevention Regulations 527 CMR 12:00 Occupancy&Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with Massachusetts Electrical Code,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date March 28,2000 City or Town of ao, Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street&Number) 59 Bonny Lane Owner or Tenant Gavin Taylor Owner's Address Same Is this permit in conjunction with a building permit: Yes 0 No = (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead =Undgrd-=No.of Meters * New Service Amps Volts Overhead =Undgrd =No.of Meters Number of Feeders and Ampacity . Location and Nature of Proposed Electrical Work Roof raise for 2 bedroom & I bathroom No.of Lighting Outlets No.of Hot Tubs No.of Transformers No.of Lighting Fixtures 11 Swimming Pool Generators No.of Receptacle Outlets 14 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switches 11 No.of Gas Burners FIRE ALARMS No.of Ranges No.of Air Cond. I Tons 4 No.of Detection 3 No.of Disposals No.of Heat Pumps kw No.of Sounding No.of Dishwashers Space/Area Heating kw No.of Self Contained No.of Dryers Heating Devices kw Local No.of Water Heaters No.of Signs Municipal No.of Hydro Massage Tubs No.of Motors Low Voltage Wiring Yes Other: 500 amp 240 volt sub panel 1 INSURANCE COVERAGE: Pursuant to requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES NO I have submitted valid proof of the same to this office YES NO If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE r-7-7 BOND �J OTHER L 1 (please specify) 2/2/01 Estimated Value of Electrical Work (Expiration Date) Work to Start March 29, 2000 Inspection Date Requested: Rough Signed under penalties of perjury: Final Upon Request FIRM NAME Dumais Electric LIC.NO. 12170A Licensee Mark A.Dumais Signature LIC. NO. 26665E Address 8 Newport Street Bus.Tel.No. 978-683-9438 Methuen,MA 01844 Alt.Tel No. 978-685-4553 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or it's substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (please check one) Telephone No. Permit Fee (Signature of Owner or Agent) i Lib►ertv �/[utual, Liberty Mutual Insurance ,! t�1. New England Region Genual Property Unit INSURANCE 75 Sylvan Street Danvers,MA 01923 Tel:(800)566-0323 March 10,2015 Town of North Andover Attn: Building Inspector 120 Main Street North Andover,MA 01845 Re: Property Address: 59 Bonny Ln,North Andover,Ma 01845 Policy Number: H3221816363221 Underwriting Company: Liberty Mutual Fire Insurance Company Claim Number:031472746-0001 Date of Loss:2/3/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, § 313, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, 5 3A & B, or Mass. General Laws, Ch. 143, 5 9, or Mass. General Laws,Ch. 111,§ 127B. This letter should not be construed as a waiver or estoppel of any of the terms,conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address,policy number,claim number,and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 i I Date . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . . . .. �� has permission to perform . ..5'G%� ��rtr 7—a wiring in the building of . . . . ��?4ivxl. . . . . . . . . . . . . . at . . . . ..,!� . . . . . , North Andover, Mass. Fee .. . . . . Lic. No. . .-�--ZA . . . . . . . . ELECTRICAL INSPECTOF2 Check --- 11001 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. p Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) S9 Bo," rt Owner or Tenant poyw4-- -Tat yla& Telephone No. Owner's Address _ .S"y Bonn 1i Lh Is this permit in conjunction with a building permit? Yes R1 No ❑ (Check Appropriate Box) Purpose of Building XP.S'te WC9- Utility Authorization No. Existing Service JLO Amps //Q/o'2,),©Volts Overhead❑ Undgrd❑ No.of Meters New Service (o Amps /I4/ 9aDVolts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity 1 Lobation and Nature of Proposed Electrical Work: sv� �a,4 1 f„,�SPfr„pt r °����nf d��lpw SIWAP/y+ Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No.of�witches No.of Gas Burners No.of Detection and Initiating Devices TotNo.of:Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW _ No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection No.of Dryers Heating Appliances KW Security Systems:X y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E q uivalent OTHER: ,�� Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 'PJ 04 (When required by municipal policy.) Work to Start: 9 // /� Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: . $e;/v47—gp-e- 0. a LIC.NO.: Sa Off,3°-,:E Licensee: D. Signature LIC.NO.: (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: Address: Cc Gnr die%Q ST A.n,esd�iey,� 1 O/913 Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work require Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: Signature Telephone No. t f7 . '�ssetX +aileft-�j �3e-xnspectZourettut'egal-L..nn\ � 3�uspeIto WAS (fnsp 040 re sign a eials) plate till 3.'asser��-• l:+'ailetl--j � � �e-inspectio�.xea�u3xe�($ 0.00)-•j � _ �spectars'coxnmextts: , (fi.sX bctoxs°gzgn tore o xxL4Hals) Slate 'assecl--� j �+'ailetl-j � �Ze xvspectia�xec�uixe�T(�50.00)�j ] inspectors'comuents: (lnspectoxs�uignatuxe��aoiiu`ftaxs) Date •� sse�--j ) X+'aiieu� j vw4uspeed;nrequired($50.00)-j �•�nectbxs'eoxnz�tepfs: . gusp ectoral M.guatuxe-io W-gals) Date e cl--j � �'azlerl•--•j ]. '�e�nsp ectioxt requix'ecl($�0.0 D)•-[ � - actors'coxnmants: _ . • S ' .. �.1iRsp ectors��zgnatuxe�74o xnitzals) date i I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a etiaployer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.. I am a sole proprietor or partner- listed on the attached sheet.t E]Remodeling (((((( ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submr t this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check th is box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer t`vat is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ./Yl. Policy#or Self-ins.Lic.#: CL la 1?70 2/y9 Expiration Date:_ Job Site Address:_ S 9 gowiq Lh City/State/Zip: A/ �t c�ov�, /Yl f 016,V15_ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. i do hereby certify under the pains and Penalties of perjury that the information provided above is true and correct. 3i%znature l ' Date: F17/3 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: --a Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall t enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." ` Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their f self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05